Normative Theories and Bioethics

The revival of normative ethics in the 1960s was associated with a general renewed interest, across Western culture, in applied ethics and especially in bioethics. Rational reflection on the difficult ethical issues associated with the expanded technological resources of the biological sciences demanded a theoretical structure of some richness, and the classical normative theories provided that structure.

The conflicts between deontological and consequentialist theories have been particularly salient in discussions within bioethics. Indeed, some general discussions of bioethics and many popular textbooks treat these two options as if they are the only possible theoretical perspectives. Part of the explanation for this is surely that so many of the ethical problems in medical practice, as well as in the biological sciences more generally, involve questions about whether actions that are generally regarded as morally problematic can be justified in cases where they appear to promise great benefits. Examples of this kind of conflict are plentiful in contemporary bioethics: Can information obtained by a physician in a doctor-patient encounter be revealed to a third party without the patient's consent, if doing so will prevent some great harm? Can physicians lie to their patients in cases where doing so will increase the effectiveness of therapy and decrease the chances of severe depression? Can physicians override the religious objections of patients to certain therapies when it is clear that these therapies will provide important benefits to the patients?

Moral difficulties like these have been at the center of contemporary discussions in bioethics from its inception. They lend themselves to an analysis that regards them as embodying a general conflict between the thought that some actions (e.g., revealing confidential information, lying, or paternalistic interference) are simply not to be done and the thought that one should be prepared to do whatever is necessary so that things go as well as they can. This conflict in turn seems very close to the fundamental issues at stake between the deontologist and the consequentialist.

Until recent years, virtue theories have been conspicuously absent from most discussions of bioethics. The renewed interest in these approaches is associated with their revival within moral philosophy generally. But there are also features of contemporary bioethics that explain the attention they receive. First, a kind of impasse has developed between consequentialist and deontological approaches to some bioethical problems, and bioethicists have turned to virtue theories with the hope that they can avoid this impasse. Second, there is a new interest in questions about the character of the various agents (e.g., physicians, nurses, researchers, and technicians) who work in settings where bioethical issues arise. This interest in character is partially a reflection of impatience with "quandary ethics." It also, however, grows out of the search for new models of moral education. Molding and shaping character has seemed to many a more attractive goal for moral education than the goal of inculcating rules. Shaping character indeed seems especially important in bioethics, where change is endemic and rules become outdated quickly.

Finally, virtue theories seem to be attracting more attention within bioethics because of the strong analogies between the notion of health and overall biological fitness, on the one hand, and, on the other, the more general notion of human flourishing that lies at the heart of virtue theories. For those who think that bioethical issues are best approached by getting clear on the goals of the biomedical sciences, this analogy is likely to lead them to take virtue theories seriously.

In spite of the recent revival of virtue ethics both within bioethics and within moral philosophy more generally, however, the dominant argumentative strategies in bioethics continue to be drawn from the deontological and consequentialist traditions. Nevertheless, each of the three traditions is now represented in the contemporary bioethical discussion by competent and enthusiastic advocates, and it seems certain that the central problems within bioethics will continue to be discussed in terms contributed by these normative traditions.

W. DAVID SOLOMON (1 995) BIBLIOGRAPHY REVISED

SEEALSO: Care; Casuistry; CommunitarianismandBioethics; Contractarianism and Bioethics; Double Effect, Principle or Doctrine of; Emotions; Obligation and Supererogation; Human Rights; Natural Law; Principalism; Utilitarianism; Virtue and Character; and other Ethics subentries

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